Point-of-care ultrasound use, accuracy, and impact on clinical decision making in Rwanda hospitals.

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Journal Title

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

MeSH Headings

Adult, Clinical Competence, Clinical Decision-Making, Cohort Studies, Educational Measurement, Female, Hospitals, Humans, Male, Middle Aged, Point-of-Care Systems, Practice Patterns, Physicians', Reproducibility of Results, Rwanda, Sensitivity and Specificity, Utilization Review


OBJECTIVES: Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies.

METHODS: We conducted point-of-care ultrasound training for physicians from Rwandan hospitals. Physicians then used point-of-care ultrasound and recorded their findings, interpretation, and effects on patient management. Data were collected for 6 months. Trainee studies were reviewed for image quality and accuracy.

RESULTS: Fifteen participants documented 1158 ultrasounds; 590 studies (50.9%) had matched images and interpretations for review. Abdominal ultrasound for free fluid was the most frequently performed application. The mean image quality score was 2.36 (95% confidence interval, 2.28-2.44). Overall sensitivity and specificity for trainee-performed examinations was 94 and 98%. Point-of-care ultrasound use most commonly changed medications administered (42.4%) and disposition (30%).

CONCLUSIONS: A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.



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